Journal
FRONTIERS IN NEUROLOGY
Volume 5, Issue -, Pages -Publisher
FRONTIERS MEDIA SA
DOI: 10.3389/fneur.2014.00165
Keywords
hypersomnia; cognitive fluctuations; sleep; review; brain networks
Categories
Funding
- Knight Alzheimer's Disease Research Center of Washington University School of Medicine
- McDonnell Center for System Neuroscience - National Institutes of Health [AG008051, AG040211]
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Subcortical circuits mediating sleep wake functions have been well characterized in animal models, and corroborated by more recent human studies. Disruptions in these circuits have been identified in hypersomnia disorders (HDs) such as narcolepsy and Kleine Levin Syndrome, as well as in neurodegenerative disorders expressing excessive daytime sleepiness. However, the behavioral expression of sleep wake functions is not a simple on-or-off state determined by subcortical circuits, but encompasses a complex range of behaviors determined by the interaction between cortical networks and subcortical circuits. While conceived as disorders of sleep, HDs are equally disorders of wake, representing a fundamental instability in neural state characterized by lapses of alertness during wake. These episodic lapses in alertness and wakefulness are also frequently seen in neurodegenerative disorders where electroencephalogram demonstrates abnormal function in cortical regions associated with cognitive fluctuations (CFs). Moreover, functional connectivity MRI shows instability of cortical networks in individuals with CFs. We propose that the inability to stabilize neural state due to disruptions in the sleep wake control networks is common to the sleep and cognitive dysfunctions seen in hypersomnia and neurodegenerative disorders.
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